In May 2015, the Heart Rhythm Society released a consensus statement recommending that remote monitoring become the standard of care for patients with cardiovascular implantable electronic devices. The panel argued that remote monitoring helped check the devices’ electronic integrity and functionality and improved patient adherence.
A recent nationwide cohort study confirmed the benefits of remote monitoring. Still, lead researcher Jonathan P. Piccini, MD, MHSc, of Duke University Medical Center in Durham, North Carolina, and his colleagues noted that most patients do not use remote monitoring. They published their results online in Heart Rhythm on Aug. 17.
The researchers analyzed the Truven Health Analytics MarketScan commercial and Medicare supplemental claims databases and identified 92,566 patients implanted with a cardiac implantable electronic device between March 31, 2009 and April 1, 2012. Patients were required to be at least 21 years old and have insurance coverage for the 12 months before and after implantation.
The mean age of the patients was 72 years old, and 63 percent were males. Of the patients, 59 percent had a pacemaker, 30 percent had an implantable cardioverter defibrillator and 11 percent had cardiac resynchronization therapy.
Only 37 percent of patients used remote monitoring, according to the researchers. Patients who received remote monitoring were slightly younger, more commonly male, more likely to have heart failure and ventricular arrhythmias and less likely to have atrial fibrillation and cerebrovascular disease. The groups had similar mean Charlson Comorbidity Index values.
After a mean follow-up period of 19 months, patients using remote monitoring had a significantly lower all-cause hospitalization and a significantly shorter mean length of hospitalization stay during the follow-up period compared with those who did not use remote monitoring.
The mean hospitalization cost per patient-year was $8,720 for patients using remote monitoring and $12,423 for patients who did not use remote monitoring.
The researchers added that for every 100,000 patient-years, remote monitoring was associated with 9,810 fewer hospitalizations, 119,000 fewer days in the hospital and $370,270,000 lower hospital payments.
They added that the study had a few limitations, including its retrospective, observational design, which mean the results do not establish causality. They mentioned that residual or unmeasured confounding could have influenced the results. In addition, they did not have information on the frequency and characteristics of or specific reactions to remote monitoring transmissions.
“Our results should be informative to healthcare systems seeking to reduce hospitalization, encouraging access and maximal adoption of [remote monitoring] with incorporation of [remote monitoring] data into clinical care,” the researchers wrote. “Notably, 21 percent of patients in the population did not have any documented follow-up (remote monitoring or in-person) within 120 days of their device implant. This also represents a significant opportunity for quality improvement.”